Teaching America How to Assess Wounds

Last week I presented at the Center for Medicare and Medicaid Service’s (CMS) Train-the-Trainer program in Las Vegas for the introduction of Minimum Data Set (MDS) 3.0 which will go into effect October 1, 2010. This assessment tool will impact 17,000 nursing homes and 1.6 million people who reside in them across America. My assignment was to introduce Section M: Skin Condition, which represents the assessment for pressure ulcers and other wounds.

MDS 3.0 is the revised version of Minimum Data Set Version 2.0 that has been in use since the early 1990’s. This assessment tool is part of the Resident Assessment Instrument (RAI), and is mandatory for all residents of skilled nursing facilities that receive reimbursement from Medicare. The purpose of the tool is multifold, as it provides the backbone for care planning, generates quality indicators, and is the vehicle which determines facility reimbursement. The prior version came under criticism as it did not incorporate current concepts and terminology, and assessment standards and left many of the nursing home residents’ needs unmet.

The entire tool has been upgraded and expanded, and Section M: Skin Condition has nearly doubled in size. This expansion directly reflects CMS’s concern regarding the negative impact of pressure ulcers on debilitated residents of nursing homes. Major changes include revised ulcer staging guidelines, incorporation of present-on-admission data, ulcer measurements, and bookkeeping for ulcers that improve or worsen. Guidelines for completing Section M are complex, and comprise over fifty pages in the RAI user’s manual. Preparation for my two hour lecture required quite a bit of study and extensive discussions with CMS representatives to go over the finer regulatory requirements

The Las Vegas MDS training was the latest in a series of week-long teaching sessions offered by the government in preparation for the official installment of MDS 3.0. Planned and sponsored by CMS, this extraordinary conference was free to nursing home staff and allowed for unique access not only to expert instructors but the technical personnel who designed the tool. Over 1000 people attended with representatives from nearly every state, and my 8:00 AM session lasted the full two hours allotted to this topic.

Pressure ulcers are a source of pain, suffering, prolonged rehabilitation, and additional healthcare expense. With the revised and expanded Section M: Skin Condition, CMS clearly demonstrates how serious it is about bringing the epidemic of pressure ulcers under control. Lower rates of pressure ulcers translate directly to improved healthcare quality, and it was my pleasure to assist CMS in rolling out their new Skin Condition assessment tool.